国际口腔医学杂志

国际口腔医学杂志 ›› 2024, Vol. 51 ›› Issue (4): 381-391.doi: 10.7518/gjkq.2024071

• 专家笔谈 •    下一篇

牙保存相关上颌窦底提升术的临床应用

谭学莲1(),满毅2,黄定明1()   

  1. 1.口腔疾病防治全国重点实验室;国家口腔医学中心 国家口腔疾病临床医学研究中心;四川大学华西口腔医院牙体牙髓病科 成都 610041
    2.口腔疾病防治全国重点实验室;国家口腔医学中心 国家口腔疾病临床医学研究中心;四川大学华西口腔医院种植科 成都 610041
  • 收稿日期:2024-04-15 修回日期:2024-04-30 出版日期:2024-07-01 发布日期:2024-06-24
  • 通讯作者: 黄定明
  • 作者简介:谭学莲，副教授，博士，Email：<email>tanxuelian@scu.edu.cn</email>
  • 基金资助:
    四川大学华西口腔医院临床研究项目(LCYJ-MS-202304);四川大学华西口腔医院探索与研发项目(LCYJ2019-19);四川省科技计划重点研发项目(2021YFS0031)

Clinical applications of natural tooth-related maxillary sinus floor elevation

Xuelian Tan1(),Yi Man2,Dingming Huang1()   

  1. 1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    2.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2024-04-15 Revised:2024-04-30 Online:2024-07-01 Published:2024-06-24
  • Contact: Dingming Huang
  • Supported by:
    Clinical Research Program of West China Hospital of Stomatology Sichuan University(LCYJ-MS-202304);Exploration and Research and Development Project of West China Hospital of Stomatology, Sichuan University(LCYJ2019-19);Key Research and Development Project of Science and Technology Plan of Sichuan Province(2021YFS0031)

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摘要：

上颌后牙是牙髓根尖周疾病的常见发病部位，在解剖上与上颌窦关系密切，炎症易扩散引发牙髓源性上颌窦炎。非手术治疗无效的难治性病例，常需联合进行显微根尖手术和上颌窦底提升术，笔者将其命名为牙保存相关上颌窦底提升术。上颌牙-牙槽骨-上颌窦复合体是该手术的解剖学基础，本文结合文献回顾及临床经验，详细讨论了牙保存相关上颌窦底提升术的应用场景及优势、适应证与禁忌证、治疗计划制定以及术式选择等关键问题，旨在探讨牙保存相关上颌窦底提升术在治疗上颌后牙牙髓源性上颌窦炎疾病中的临床应用，为该技术的临床应用提供了理论依据，同时为进一步规范其临床操作路径和制订多学科联合管理策略打下坚实的基础。

关键词: 上颌牙-牙槽骨-上颌窦复合体, 牙保存相关上颌窦底提升术, 牙源性上颌窦炎, 临床应用

Abstract:

The posterior maxillary teeth are common sites of endodontic periapical diseases and are connected to the maxillary sinus, facilitating the spread of infection and leading to odontogenic maxillary sinusitis. The maxillary tooth-bone-sinus complex exhibits a close anatomical relationship, necessitating procedures for refractory cases. For surgical access, microscopic apical surgery is often combined with maxillary sinus floor elevation, termed “natural tooth-related maxillary sinus floor elevation”, to ensure therapeutic efficacy and reduce complications. This paper provides a comprehensive discussion on the application scenarios, advantages, indications and contraindications, treatment planning, and selection of surgical procedures for tooth preservation-related maxillary sinus floor elevation. Drawing from a combination of literature review and clinical experience, this work explores the clinical applications of this technique and provide preliminary theoretical guidance on its clinical application and a solid foundation for further standardization of the clinical operation path and multidisciplinary joint management strategy.

Key words: maxillary tooth-bone-sinus complex, natural tooth-related maxillary sinus floor elevation, odontogenic maxillary sinusitis, clinical application

中图分类号: 

  • R78

图1

右上第一磨牙显微根尖手术联合上颌窦底侧壁提升术A：术前影像学评估；a、b、c示上颌窦黏膜增生，颊、腭侧骨板破坏，上颌窦底穿通，根尖周病损与上颌窦增生黏膜融为一体，颌骨缺损大小约1.4 cm×1.4 cm×1.2 cm；d、e示根尖上方穿通的上颌窦底边缘残存的窦底骨及骨量；f、g示术前CBCT三维重建，设计骨开窗范围，保护上颌窦纵膈及小血管分支；B：设计并制作数字化导板；C：16牙显微根尖手术联合上颌窦底侧壁提升术，CGF为浓缩生长因子 （concentrated growth factor）；D：术后影像学检查；a示术后即刻X线片显示倒充填完善；术后4月CBCT检查，b示上颌窦黏膜未见增厚，窦底骨板部分恢复，c示颊腭根未见暗影，牙周膜影像恢复，根分叉新骨形成，d示自体骨骨板恢复良好，颊侧骨板修复再生。"

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